Systems and methods for forming materials in situ within a medical device

ABSTRACT

A method for forming a material in an in situ medical device by initiating polymerization of water soluble polymer precursors in an aqueous solution during or after transport of the polymerizable solution from its storage container to a space inside the in situ medical device is described. The stored aqueous solution with water soluble precursors lacks a free radical initiator which, in a powder form, is introduced into the aqueous solution during or after its transport into the space inside the in situ medical device. This storage and delivery system provides greater stability to the stored aqueous solution, allowing it to be stored at ambient temperature and providing extended shelf life over the solutions used in existing in situ polymerization systems. The flexibility to store and deliver/transport only one aqueous solution, instead of requiring the use of two different solutions, is also a benefit.

This application is a continuation of U.S. patent application Ser. No.14/776,385, filed Sep. 14, 2015, which is a National Stage Entry ofPCT/US2014/021928, filed Mar. 7, 2014, which claims priority to U.S.Provisional Patent Application No. 61/785,445 filed on Mar. 14, 2013 andentitled “Method for Forming Materials In Situ Within a Medical Device,”the full disclosures of each of which are incorporated herein byreference.

BACKGROUND

Abdominal Abdominal Aortic Aneurysms (AAA) are weakened areas in theaorta that form balloon-like bulges, or sacs, in approximately theabdominal area. As blood flows through the aorta, the pressure of theblood pushes against the weakened wall, causing it to enlarge and oftenrupture. Ruptured AAA is a major cause of death in the United States.

In the past, clips and open surgery were the traditional interventionaltreatments for AAA. More recently, endografts, sometimes with stents foradded stability, have been placed across the aneurysm to reduce thepressure on the aneurysm wall and prevent its enlargement and rupture.

Most recently, there have been described systems wherein an expandablemember of a device is introduced into the aneurysmal sac by means ofminimally invasive surgical (MIS) techniques, e.g., guidance through thevasculature of a human patient using a guidewire introduced into thepatient for that purpose. Flowable precursor materials are introducedinto the expandable member, the precursor materials undergo chemicalreaction and cause the expandable member to expand and conform to theshape of the aneurysmal sac. As the materials harden, they lock theexpandable member in place in the patient and stabilize the aneurysm.See for example, U.S. Pat. Pub. Nos. 7,872,068; 8,044,137; and U.S.2006/0222596, the contents of which are hereby incorporated by referenceherein in their entirety. The expandable member may be, for example, asingle-walled or double-walled balloon or an inflatable cuff. Otherexamples of devices having an inflatable or expandable member areprovided, for example, in PCT Application Pub. No. WO 00/51522, U.S.Pat. Pub. Nos. 5,334,024; 5,330,528, 6,1312,462; 6,964,667; 7,001,431;2004/0204755; and 2006/0025853A1, the contents of which are herebyincorporated by reference herein in their entirety. The flowableprecursor materials are typically polymer precursors which polymerizeand cross-link to form hydrogels. One preferred type of polymerprecursor is a material that can be polymerized by free radicalpolymerization. Typically this involves the polymerization/cross-linkingof two prepolymers, each having terminal reactive groups that aresusceptible to free radical polymerization, such as acrylates andmethacrylates.

The polymerization is effected by combining both prepolymers with athermally activated low temperature free radical initiator and aninitiator catalyst at physiological temperature.

In order to avoid premature polymerization, i.e., prior to mixing allthe components and allowing them to polymerize in situ in the expandabledevice, the components are typically stored in two separate aqueoussolutions, one solution comprising one polymer precursor and the freeradical initiator, and the other solution comprising the other polymerprecursor and the initiator catalyst. In this way, the two polymerprecursors are kept apart, as are the free radical initiator and theinitiator catalyst.

In practice, the two solutions are concomitantly delivered and thenmixed, either ex vivo in a manifold, or in the expandable device itself.

Because of the instability of thermally activated low temperature freeradical initiators, the solutions containing the components mustnecessarily be kept frozen, i.e., at zero degrees Celsius or lower,until needed. Even so, the useful shelf life of the device or kitcomprising such solutions is only 12 to 18 months.

The necessity that the solutions be kept frozen is a serious practicaldisadvantage, inasmuch as the solutions cannot easily be thawed and beready for use as soon as a patient presents with an AAA that needsimmediate treatment, particularly since rapid thawing by conventionaltechniques using large temperature differentials, e.g., hot water ormicrowave defrosting, cannot be used because of the thermal activationof the initiator.

It would be desirable to have materials and methods for using suchmaterials, such that storage of the aqueous solutions used for treatmentcould be at or near ambient temperature, allowing for immediate use whenrequired, and having a useful shelf life of at least 2 years.

It would further be desirable to be able to administer only onesolution, rather than two, thus avoiding the necessity for mixing in amanifold or other device, and ensuring homogeneity of the material beingpolymerized.

SUMMARY OF THE INVENTION

What is needed is an improved method for stabilizing AAA-treatingdevices. These methods are described herein, including materials andmethods of stabilizing implanted medical devices by introducing flowableprecursor materials that expand an expandable member of the device toset the device in place, with the precursors then hardening to keep thedevice in place. Previous devices and methods have been described indetail in, e.g., U.S. Pat. No. 8,044,137, cited above, the contents ofwhich are hereby incorporated by reference herein in their entirety.

Embodiments described herein provide methods that allow for simpler andmore practical stabilization of implanted medical devices, inparticular, elimination of the need to keep the materials frozen untiluse, increased shelf life, and the ability to use only one solution toinitiate the process.

In particular, one embodiment is directed to a method of forming amaterial in situ by increasing the volume of an expandable member of amedical device in a patient by:

-   -   a. introducing into a tube in communication with a space inside        the expandable member, or directly into the expandable member, a        flowable aqueous solution comprising a first and a second water        soluble polymer precursor, each water soluble polymer precursor        having terminal functional groups, and, optionally, an initiator        catalyst,    -   b. introducing into the flowable aqueous solution from step (a)        a thermally activated low temperature free radical initiator in        powder form,    -   c. allowing the free radical initiator to dissolve in the        flowable aqueous solution,    -   d. if not previously introduced in step (a), introducing the        initiator catalyst into the solution from step (c), and    -   e. allowing functional groups on the polymer precursors to        undergo covalent bonding to form a solid and substantially        non-biodegradable material in the space inside the expandable        member.        The flowable aqueous solution may be formed by the mixture of a        first and a second source solution, each introduced into a        separate filling tube, each source solution comprising one of        the polymer precursors, or if only one source solution        comprising both the first and second polymer precursors is        employed, the flowable aqueous solution is identical to the one        source solution and is introduced into a single filling tube.        The catalyst may be present in a source solution, or added        before or after the initiator is introduced.

This method allows for the free radical initiator to be absent from thesource solutions being introduced and, instead, to be kept in powderform and introduced into the flowable aqueous solution only at the timethe polymerization is desired. This material in powder form may bepresent in a filter upstream from the expandable member, in theexpandable member itself, or in a container in communication with theexpandable member. As a result of the free radical initiator not beingpresent in the source solution(s), it is now possible and desirable tocombine both polymer precursors into one source solution, and therebyadminister a single source solution to initiate the polymerizationprocess.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts a schematic cross-section of a prior art apparatus.

FIG. 2A depicts a schematic cross-section of an embodiment of a filterunit.

FIG. 2B depicts a schematic cross-section of another embodiment of afilter unit.

FIG. 2C depicts a schematic cross-section of an embodiment of anintegrated manifold/filter unit.

FIG. 3 depicts a schematic cross-section of an embodiment of anexpandable member.

FIG. 4 depicts a schematic cross-section of an embodiment of anapparatus used to practice the method described herein.

FIG. 5 depicts a schematic cross-section of another embodiment of anapparatus used to practice the method described herein.

FIG. 6 depicts a schematic cross-section of another embodiment of anapparatus used to practice the method described herein.

FIG. 7 depicts a close up schematic cross-section of the expandablemember from FIG. 6.

FIG. 8 depicts a schematic cross-section of a portion of anotherembodiment of an apparatus used to practice the method described herein.

The drawings are intended to depict various components and theirrelationship to each other. The components are not drawn to scale.

DETAILED DESCRIPTION

As discussed above, previous methods for treating AAA have includedforming a material in situ by increasing the volume of an expandablemember of a medical device. The expandable member when expanded byflowable material conforms to the shape of the aneurysm in which it iscontained, and once allowed to harden, fixes the medical device inplace. The material is formed by the free radical polymerization of twopolymer precursors in an aqueous solution in the presence of a thermallyactivated free radical initiator and an initiator catalyst. Thepolymerization is carried out, for example, inside an endograftcomprising a single-walled or double-walled balloon.

FIG. 1 depicts an embodiment of a typical prior art apparatus 10 used topractice previous methods. Two solutions 13A, 13B are in containers 11A,11B, for example, syringes, that communicate with filling tubes 12A,12B. In this configuration, one solution comprises a first polymerprecursor and either the initiator or the catalyst, and the othersolution comprises a second polymer precursor and the other of theinitiator and the catalyst. The solutions 13A, 13B are delivered underpressure to a manifold 16 where they are mixed. The manifold maycomprise various structures to ensure thorough mixing. The resultingsolution is then delivered via tube 14 to the expandable member 15 wherepolymerization occurs, the expandable member expands to conform to theshape of a surrounding aneurysm (not shown), and time passes to allowthe polymerization to progress. Once solution delivery is concluded (thetermination of solution injection can be based on pressure sensorsattached to the pressurized tubing, e.g., tube 14, or on the basis ofachieving delivery of a premeasured or calculated volume needed to fillthe aneurysmal space which is desired to be occupied), the tube 14 iswithdrawn from the expandable member allowing the polymerizing mixtureto be sealed within the expandable member 15. The medical devicecomprising the expandable member is typically delivered to the site ofthe aneurysm in the patient by means of a catheter that is put intoplace over a guidewire. In another embodiment there is no manifold andthe two solutions are mixed in the expandable member.

The presence of the initiator in one of the solutions being introducedis problematic in that it necessitates that the solutions and,therefore, the entire apparatus, be kept frozen, and thawed onlyimmediately before delivering into a catheter for treating a patient.Thawing by traditional means involving large temperature differentialssuch as hot water or microwave treatment is not possible due to thethermal activation of the initiator. At ambient temperature theinitiator in the solution is unstable and can result in degradation ofthe polymer precursor, such as and including premature polymerization,resulting in an unacceptable shelf life.

It has now been found that, surprisingly, by eliminating the initiatorfrom the solution, and introducing it in powder form later in theprocess, (i) one can avoid having to store the apparatus containing thesolutions at freezer temperature, (ii) overall shelf life can beimproved, (iii) both polymer precursors can be combined into onesolution for delivery, greatly simplifying the procedure, and (iv) theresulting hydrogel is of a quality substantially the same as thatprepared by previous methodologies.

Thus, in its broadest aspect, a method described includes a method offorming a material in situ by increasing the volume of an expandablemember of a medical device in a patient by:

-   -   a. introducing into a tube in communication with a space inside        the expandable member, or directly into the expandable member, a        flowable aqueous solution comprising a first and a second water        soluble polymer precursor, each water soluble polymer precursor        having terminal functional groups, and, optionally, an initiator        catalyst,    -   b. introducing into the flowable aqueous solution from step (a)        a thermally activated low temperature free radical initiator in        powder form,    -   c. allowing the free radical initiator to dissolve in the        flowable aqueous solution,    -   d. if not previously introduced in step (a), introducing the        initiator catalyst into the solution from step (c), and    -   e. allowing functional groups on the polymer precursors to        undergo covalent bonding to form a solid and substantially        non-biodegradable material in the space inside the expandable        member.

Particularly preferred polymer precursors are those that, uponpolymerization and cross-linking, will result in a hydrogel havingcertain desired properties, most notably being a solid andnonbiodegradable material having a swellability of less than about 20%v/v and having a Young's modulus of at least about 100 kiloPascals. Tominimize the time required for the MIS (minimally invasive surgical)procedure, but allow sufficient time for the removal of filling tubesfrom the expandable member, it is preferred that the time for formingthe finished hydrogel be from about 30 seconds to about 30 minutes frominitiating the polymerization reaction. The polymerization reaction isinitiated by the mixture of both polymer precursors, the initiator andthe catalyst in solution.

It is preferred that the polymer precursors be water soluble, be solublewith each other, have similar polymerization reactivity to ensure thehydrogel is a random copolymer, and have terminal functional groups.Polymer precursors comprising polyethyleneoxide units, i.e.,polyethylene glycols (PEGS), with terminal acrylate or methacrylatefunctional groups, are particularly preferred. It is also preferred thatthere be a first polymer precursor that is linear and a second polymerprecursor that is branched. The linear polymer precursor provides along-chain, durable and flexible base for the hydrogel, and the branchedpolymer precursor provides a high degree of cross-linking for thehydrogel with a network structure having the desired swellability andhardness. A particularly preferred linear polymer precursor ispolyethylene glycol terminally derivatized with two acrylate groups andhaving a molecular weight between about 20 and 50 kiloDaltons, mostpreferably about 35 kiloDaltons. A particularly preferred branchedpolymer precursor is an oligomeric branched polyethylene glycolterminally derivatized with three acrylate groups and having a molecularweight of between about 800 Daltons and 1.2 kiloDaltons, most preferablyabout 1 kiloDalton. The molar ratio of branched polymer precursor tolinear polymer is preferably between about 200:1 and about 1000:1, mostpreferably about 400:1.

Thermally activated low temperature free radical initiators willinitiate free radical crosslinking reactions at or near physiologicalbody temperatures. Particularly preferred initiators are sodiumpersulfate, potassium persulfate and ammonium persulfate. Ammoniumpersulfate is particularly preferred because of its high watersolubility, thereby assuring its complete solubility during theprocesses described.

Initiator catalysts are used to initiate the polymerization reaction byreaction with the initiator. Preferred catalysts include triethanolamineand tetramethylethylenediamine. Triethanolamine is particularlypreferred. It is generally preferred that the initiator and catalyst bepresent in about equimolar amounts and that the molar ratio of branchedpolymer precursor to initiator be from about 2:1 to about 15:1,preferably about 7:1.

The aforementioned components (both polymer precursors and, optionally,catalyst) are dissolved in one or two source solutions, preferably inbuffered aqueous solutions such as phosphate buffered solutions having apH desirable for stability of the ester linkages, preferably neutral toslightly acidic, pH 4-7, and providing a hydrogel having a neutralosmolarity with respect to physiological conditions. The initiator as apowder is dissolved later. Sufficient buffered source solution is usedto reduce viscosity and ensure that the source solution(s) is flowable.If two source solutions are employed, the first source solutioncomprises the first polymer precursor and the second source solutioncomprises the second polymer precursor. The catalyst may be present inone of the source solutions or it may be added later, either before orafter introduction of the initiator. Preferably, the catalyst is presentin one of the source solutions. In addition, one of the source solutionstypically also comprises a radio-opaque agent such as sodium diatrizoatefor fluoroscopic visualization. For ease of delivery it is preferablethat about equal volumes of the two source solutions be employed. Ifonly one source solution is employed, both polymer precursors,optionally the catalyst, and a radio-opaque agent are present.Preferably the catalyst is present in the source solution.

In one embodiment depicted in FIG. 2A a filter unit 20A comprises afilter 18. The initiator 17A in powder form is disposed on the upstreamside of the filter. The filter unit is disposed in the tube 14 upstreamfrom the expandable member. As the flowable aqueous solution passesthrough the filter unit, the initiator dissolves therein.

In another embodiment the initiator in powder form 17B is immobilized onthe upstream side of the filter 18. This is depicted in FIG. 2B. Theimmobilization may be effected, for example, by capturing the initiatorin a sponge or scaffold, by trapping it in small pores or in an erodiblesolid.

In yet another embodiment depicted in FIG. 2C, two source solutions areutilized and the manifold and filter are shown as integrated into asingle unit 20C.

In the aforementioned embodiments in FIGS. 2A-C the filter may beconstructed of PTFE, PVDF, polysulfone, polypropylene and othercompatible materials with pores sufficiently small to prevent thepassage of initiator powder therethrough, but able to allow the passageof solution under pressure without impediment. The arrows depict thedirection of flow. A variety of commercially available filter units withthe above properties may be used, for example, a 33 mm Millex GP 0.22 μmfilter.

In another embodiment depicted in FIG. 3 the initiator in powder form17C is disposed in the expandable member 15. This material thendissolves in the flowable aqueous solution as it flows into theexpandable member.

One embodiment of an apparatus 40 used to practice the method describedis depicted in FIG. 4. The two source solutions 19A, 19B, eachcomprising one polymer precursor, with one source solution comprisingthe catalyst, are delivered to manifold 16 and the resulting flowableaqueous solution then is delivered to filter 18 having initiator 17A (or17B) in powder form disposed on the upstream side thereof and, after thepowder dissolves, the resulting solution passes through the filter andis delivered to expandable member 15.

Another embodiment of an apparatus 50 used to practice the methoddescribed is depicted in FIG. 5. In this embodiment only one sourcesolution 21 is utilized. This solution comprises both polymer precursorsand the catalyst, and is delivered to the filter 18 having initiator 17A(or 17B) in powder form disposed on the upstream side thereof and, afterthe powder dissolves, the resulting solution passes through the filterand is delivered to expandable member 15.

Another embodiment of an apparatus 60 used to practice the methoddescribed is depicted in FIG. 6. A single source solution is delivereddirectly to the expandable member 15, depicted as partially expanded. Asmall portion, for example, 5-10% of the volume of delivered solution 26is withdrawn via tube 22 into a container 23, for example, a syringe,containing initiator 17D in powder form. After the powder dissolves indelivered solution 26 the resulting solution is returned to theexpandable member via tube 22, mixed with delivered solution 26 in theexpandable member, and the polymerization reaction is allowed toproceed. In a variation on this embodiment, two source solutions areinitially delivered to the expandable member.

FIG. 7 depicts a detailed embodiment of the expandable member 15 fromFIG. 6 after the solution containing the initiator has been returned viatube 22. The resulting solution 24 undergoes polymerization. In order toensure thorough mixing of returning solution containing initiator withdelivered solution 26 in the expandable member, the distal portion oftube 22 is shown as extending essentially to the distal end of theexpandable member. The distal portion of tube 22 also is shown as havinga plethora of ports 25 spaced annularly around the distal portion oftube 22. In this manner, solution returning via tube 22 can mix morethoroughly with delivered solution 26 to ensure a more homogeneous mixedsolution, and resulting in a uniform hydrogel polymer having the desiredproperties.

As described above, the catalyst may be incorporated in a sourcesolution or introduced later in the process, either before or afterintroduction of the initiator. FIG. 8 depicts a portion of oneembodiment of an apparatus 80 used to practice the present invention. Inthis embodiment two filter units 20A and 27 are connected in series.Filter unit 20A contains initiator 17A (or 17B) and filter unit 27contains catalyst 29. Flowable aqueous solution comprising both polymerprecursors flows into filter unit 20A, whereby the initiator dissolvestherein, and then flows into filter unit 27 whereby the catalyst 29dissolves therein, before being delivered to the expandable member 15.In a variation on this embodiment the two filter units are transposed sothat the catalyst is introduced into the flowable aqueous solutionbefore the initiator. The filter unit for the catalyst may be the sametype as the filter unit for the initiator.

The following Examples are illustrative only and are not intended tolimit the scope of other embodiments described in any way.

Example 1

A first source solution is prepared by mixing approximately equalweights of 0.01M pH 7.0 phosphate buffer and ethoxylated (20)trimethylolpropane triacrylate (PEG-T) (Sartomer Co., Exton, Pa.). Asecond source solution is prepared containing 4% (w/w) polyethyleneglycol diacrylate 35,000 Da (PEG-D) (JenKem Technology, Allen, Tex.) in0.01M pH 7.0 phosphate buffer. 22-23 ml of each of these sourcesolutions was transferred to individual parallel chambers of a cappeddual barrel syringe. 38 mg of ammonium persulfate powder (APS) wasplaced on the inlet side of a 33 mm Millex GP 0.22 μm filter disk andthe disk was tapped to better distribute the powder. 55 mg oftriethanolamine liquid (TEA) was placed on the inlet side of a second 33mm Millex GP 0.22 μm disk. A multiple element static mixer was attachedto the end of the dual barrel syringe. The dual barrel syringe wasplaced into a dispensing apparatus capable of dispensing equal volumesof the two solutions through the mixer. The filter containing the APSwas attached to the mixer and the filter containing the TEA was attachedin series to the outlet of the APS filter. Approximately 15 ml of eachsource solution (30 ml total) was dispensed, over 10-20 seconds, throughthe mixer and both filters sequentially into 3 glass vials placed in a37° Celsius water bath, approximately 10 ml in each vial. Polymerizationwas observed in the first vial after seven minutes, resulting in a whitesolid hydrogel.

Example 2

Equal volumes (approximately 25 ml each) of the first and second sourcesolutions from Example 1 were mixed to form a single source solution.Because only a capped dual barrel syringe was available, the resultingsingle source solution was transferred to both parallel chambers of thesyringe, approximately 22-23 ml each, and a mixing tube was connected tothe syringe, not for mixing purposes, but to provide an appropriateconnector. A 33 mm Millex GP 0.22 μm filter disk containing 27 mg of TEAliquid was attached to the end of the mixing tube and a second 33 mmMillex GP 0.22 μm filter disk containing 32 mg of APS powder wasattached in series to the outlet of the first filter. The dual barrelsyringe was placed into a dispensing apparatus capable of dispensingequal volumes of the two solutions. Approximately 15 ml from each barrel(30 ml total) was dispensed, over 10-20 seconds, through the filterssequentially into 3 glass vials placed in a 37° Celsius water bath,approximately 10 ml in each vial. Polymerization was observed in thefirst vial after nine minutes, resulting in a white solid hydrogel.

Example 3

Example 1 is repeated, except that the filters are reversed so that thefilter with the TEA is attached to the end of the mixer and the filterwith the APS is attached in series to the outlet of the first filter.Polymerization is observed, resulting in a white solid hydrogel.

Example 4

Example 2 is repeated, except that the filters are reversed so that thefilter with the APS is attached to the end of the mixing tube and thefilter with the TEA is attached in series to the outlet of the firstfilter. Polymerization is observed, resulting in a white solid hydrogel.

Example 5

Example 1 is repeated, except that 92 mg of TEA is dissolved in thefirst source solution instead of being contained in a filter.Polymerization is observed, resulting in a white solid hydrogel.

Example 6

Example 2 is repeated, except that 45 mg of TEA is dissolved in thesingle source solution instead of being contained in a filter.Polymerization is observed, resulting in a white solid hydrogel.

Example 7

A first source solution was prepared by dissolving 4.8 g of PEG-D and2.4 g of sodium diatrizoate in 112.8 g of 0.01M pH 5.0 phosphate buffer.A second source solution was prepared by dissolving 64.2 g of PEG-T and1.128 g of triethanolamine in 64.8 g of 0.01M pH 5.0 phosphate buffer.2.009 g ammonium persulfate was placed inside a polyurethane endobag. 60ml each of the source solutions were mixed for 15 minutes to form asingle source solution. That source solution was placed in a syringe andinjected into the endobag at 21° Celsius without agitation to cure thehydrogel. Complete polymerization was observed after 22 minutes and 24seconds, resulting in a solid white hydrogel.

The aforementioned embodiments according to the invention and apparatusused to practice such embodiments are illustrative only and are notintended to limit the scope of the claims hereinafter. Variations,modifications and combinations of the above embodiments will be apparentto the skilled practitioner and are included herein.

What is claimed is:
 1. A system for treatment of an aneurysm in apatient, the system comprising: an expandable member that is inflatableand adapted for delivery into and expansion within the patient; a tubein fluid communication with a space inside the expandable member; aflowable aqueous solution comprising at least one polymer precursor; anda filter disposed in the tube upstream from the expandable member, thefilter having upstream and downstream sides, wherein the filter ispermeable to the flowable aqueous solution, and wherein the flowableaqueous solution forms a solid and substantially non-biodegradablematerial in the expandable member after passing through the filter. 2.The system of claim 1, wherein a free radical initiator in powder formis disposed on the upstream side of the filter such that as the flowableaqueous solution passes through the filter, the free radical initiatordissolves therein.
 3. The system of claim 2, wherein the free radicalinitiator is a thermally activated low temperature free radicalinitiator.
 4. The system of claim 2, wherein the flowable aqueoussolution is a mixture of a first and a second source solution, whereinsaid first source solution comprises a first water soluble polymerprecursor and the second source solution comprises a second watersoluble polymer precursor.
 5. The system of claim 4, further comprisingan initiator catalyst, wherein either the first or second sourcesolution comprises the initiator catalyst.
 6. The system of claim 2,wherein the free radical initiator is sodium, potassium or ammoniumpersulfate.
 7. The system of claim 2, further comprising an initiatorcatalyst, wherein the free radical initiator and the initiator catalystare present in about a 1:1 molar ratio.
 8. The system of claim 1,wherein the flowable aqueous solution comprises a first and a secondwater soluble polymer precursor, each water soluble polymer precursorcomprising terminal functional groups.
 9. The system of claim 8, whereinthe first water soluble polymer precursor is linear and the second watersoluble polymer precursor is branched.
 10. The system of claim 9,wherein the molar ratio of the branched polymer precursor to the linearpolymer precursor is between about 200:1 and about 1000:1.
 11. Thesystem of claim 9, wherein the molar ratio of the branched polymerprecursor to a free radical initiator is between about 2:1 and about15:1.
 12. The system of claim 8, wherein the first water soluble polymerprecursor is a linear polyethylene glycol terminally derivatized withtwo acrylate groups and having a molecular weight between about 20 andabout 50 kiloDaltons, and the second water soluble polymer precursor isa branched oligomeric polyethylene glycol terminally derivatized withthree acrylate groups and having a molecular weight between about 800Daltons and about 1.2 kiloDalton.
 13. The system of claim 1, wherein theexpandable member is a double-walled balloon.
 14. The system of claim 1,wherein the expandable member is configured to be implantable within thepatient.
 15. A method of forming an implant by increasing the volume ofan expandable member for use in treatment of an aneurysm, the methodcomprising: a. introducing into a tube in communication with a spaceinside the expandable member, or directly into the expandable member, aflowable aqueous solution comprising a first and a second water solublepolymer precursor, each water soluble polymer precursor having terminalfunctional groups; b. introducing into the flowable aqueous solutionfrom step (a) a thermally activated low temperature free radicalinitiator in powder form, c. allowing the free radical initiator todissolve in the flowable aqueous solution, wherein the free radicalinitiator is disposed on a filter such that as the flowable aqueoussolution passes through the filter, the free radical initiator dissolvestherein; d. allowing functional groups on the water soluble polymerprecursors to undergo covalent bonding to form a solid and substantiallynon-biodegradable material in the space inside the expandable member.16. The method of claim 15, further comprising: introducing an initiatorcatalyst into the solution from step (c).
 17. The method of claim 16,wherein, prior to step (a), there is introduced into a filling tube asource solution comprising the first and second water soluble polymerprecursors and the initiator catalyst.
 18. The method of claim 16,wherein either a first or second source solution comprises the initiatorcatalyst.
 19. The method of claim 16, wherein the initiator catalyst isintroduced before introduction of the initiator or the initiatorcatalyst is introduced after introduction of the initiator.
 20. Themethod of claim 15, wherein the flowable aqueous solution is formed bythe mixture of a first and a second source solution, wherein said firstsource solution comprises the first water soluble polymer precursor andthe second source solution comprises the second water soluble polymerprecursor.
 21. A system for treatment of an aneurysm in a patient, thesystem comprising: an expandable member that is inflatable and adaptedfor delivery into and expansion within the patient; a tube in fluidcommunication with a space inside the expandable member; and a filterdisposed in the tube upstream from the expandable member, the filterhaving upstream and downstream sides, wherein a free radical initiatorin powder form is disposed on the upstream side of the filter such thatas a flowable aqueous solution passes through the filter, the freeradical initiator dissolves therein.